Legal & Regulatory Issues

America's Health Insurance Plans submitted comments to CMS Administrator Chiquita Brooks-LaSure on Oct. 12 over the organization's Medicare Coverage of Innovative Technology and Definition of "Reasonable and Necessary" rule. 

William Precht, a former administrator at the Louis Stokes Cleveland VA Medical Center, has been sentenced to 37 months in prison for faking medical records to embezzle from the hospital, cleveland.com reported Oct. 14.

Six hospital groups, including the American Hospital Association and Federation of American Hospitals, urged the U.S. Supreme Court to review and rectify a Sixth Circuit Court of Appeals decision they say will increase hospitals' exposure to False Claims Act lawsuits.

From an Illinois system seeking dismissal of an antitrust lawsuit to a Pennsylvania health system defending against false claims allegations, here are the latest hospital lawsuits making headlines. 

A former vice president of Janesville, Wis.-based Mercyhealth pleaded guilty Oct. 14 to wire fraud and tax evasion as part of a $3 million kickback scheme, according to The Wisconsin State Journal.

Following the Oct. 13 rollout of a new Medicaid provision for abortion providers in Missouri, CMS is launching a formal review of the policy. 

Implementing the No Surprises Act, the federal government's attempt to cut down on surprise billing practices, could slow the growth of healthcare premiums.

An opinion piece co-authored by Donald Berwick, MD, former CMS administrator, chalks up the surge of Medicare Advantage offerings in recent years to the system being a "money machine" for payers. 

UPMC is defending its surgery and billing practices after the Justice Department filed a false claims complaint against the Pittsburgh-based system, its physician group and the chair of its department of cardiothoracic surgery.

Lancaster (Pa.) General Hospital's motion to dismiss a lawsuit filed by a group of hospitals claiming it unlawfully received millions in state funding by inflating reimbursement claims was denied by a Pennsylvania federal judge Oct. 12.